Academic Health Centers Research Articles

Centrally acting ACE inhibitor (cACEi) and angiotensin receptor blocker (cARB) use and cognitive dysfunction in patients with SLE

ObjectiveCognitive dysfunction (CD) is detectable in approximately 40% of patients with SLE. Despite this high prevalence, there are no approved pharmacological treatment options for this detrimental condition. Preliminary murine studies...

Combatting Social Isolation, Anxiety, and Loneliness in Hospitalized Patients: A Quasi-Experimental Study.

The objective of this study was to determine the effectiveness of an intervention related to social isolation and loneliness among hospitalized patients by improving: 1) social connectedness; 2) anxiety; and 3) loneliness and to evaluate experiences of the connection intervention. Social isolation and loneliness can lead to detrimental effects on morbidity/mortality and health indices. A connection intervention was developed by investigators using key strategies to promote connectedness, providing in-person contact for hospitalized patients to meet individual and self-care needs. This quasi-experimental study was conducted in a Midwest adult academic health center. Social connectedness, anxiety, and loneliness were evaluated at baseline and postintervention using a paired-sample t test. Experience responses were analyzed using content analysis. There were no significant differences in social connectedness, anxiety, or loneliness when comparing baseline with postintervention. Experience themes included sharing personal stories back and forth, treating me as a person, mitigating loneliness, and finding benefit. Despite nonsignificant findings, participants found benefit in filling the social void of being an inpatient. Clinicians should ensure that holistic care is delivered to hospitalized inpatients. Inclusive patient-centered strategies targeted to decrease social isolation and loneliness among acute care inpatients should continue to be developed and tested.

Transforming the field: the role of academic health centers in promoting and sustaining equity based community engaged research.

Community-based participatory research (CBPR) and community engaged research (CEnR) are key to promoting community and patient engagement in actionable evidence-based strategies to improve research for health equity. Rapid growth of CBPR/CEnR research projects have led to the broad adoption of partnering principles in community-academic partnerships and among some health and academic organizations. Yet, transformation of principles into best practices that foster trust, shared power, and equity outcomes still remain fragmented, are dependent on individuals with long term projects, or are non-existent. This paper describes how we designed our Engage for Equity PLUS intervention that leverages the leadership and membership of champion teams (including community-engaged faculty, community partners and patient advocates) to improve organizational policies and practices to support equity based CBPR/CEnR. This article describes the feasibility and preliminary findings from engaging champion teams from three very different academic health centers. We reflect on the learnings from Engage for Equity PLUS; the adaptation of the intervention design and implementation, including the development of a new institutional assessment using mixed research methods; and our organizational theory of change. In summary, our design and preliminary data from the three academic health centers provide support for new attention to the role of institutional practices and processes needed to sustain equity-based patient and community-engaged research and CBPR and transform the field.

496-P: Diabetic Retinopathy in Youth with Type 2 Diabetes—Data from Three Academic Health Centers

Diabetic retinopathy (DR) is a microvascular complication of type 2 diabetes (T2D) and a major cause of vision loss worldwide. The TODAY study reported a DR prevalence of 51% among patients with youth onset T2D (average T2D duration 13.3 years, mean age of 26.4 years). Prevalence rates of DR in youth-onset T2D with shorter duration and younger age is unclear. In a multicenter analysis, eye exams or retinal images from patients with youth-onset T2D at Cincinnati Children’s, Johns Hopkins, and University of Wisconsin were assessed for presence of DR using t-tests and fisher’s exact test. The study included 228 youth (mean age 16.5±3.5years, mean T2D duration 3.0±2.6 years). Seven participants (3%) were positive for DR. Compared to youth negative for DR (n=221), those with DR (n=7) had a longer duration of diabetes (5.3±3.1 v. 2.9±2.6years, p=0.015) and higher hemoglobin A1c at the time of the diabetic eye exam (10.0±2.1 v. 7.5±2.6%, p=0.012). There were no differences in age, race/ethnicity, sex, or types of medication prescribed between those with and without DR. Of those with DED, when compared to all other ethnicities, NH Black youth had a higher rate of positive diabetic eye exams (p=0.04). Our study found a lower prevalence of DR in youth with T2D at younger age and shorter duration of diabetes. Further work is needed to determine the inflection point when the incidence of DR increases. Disclosure R.Channa: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. A.S.Shah: None. V.S.Shah: None. M.Bahrainian: None. E.A.Brown: None. T.Liu: None. B.Magella: None. H.Lehmann: None. M.D.Abràmoff: Board Member; Digital Diagnostics, Consultant; AbbVie Inc., NovaGo Therapeutics AG, Other Relationship; Digital Diagnostics, Stock/Shareholder; Digital Diagnostics. Funding National Eye Institute (R01EY033233, 5K23EY030911-03)

Faculty knowledge, actions, and perceptions of sponsorship: an institutional survey study

ABSTRACT Background Women and underrepresented in medicine and the health sciences (URiM) faculty face inequities in advancement. Career sponsorship may be a remedy. Few studies have described sponsorship in academic medicine and none across an institution. Objective To examine faculty awareness, experiences, and perceptions of sponsorship at a large academic health center. Design Anonymous online survey. Participants Faculty with a ≥50% appointment. Main Measures The survey contained 31 Likert, multiple-choice, yes/no, and open-ended questions about familiarity with the concept of sponsorship; experience of having or being a sponsor; receipt of specific sponsorship activities; sponsorship impact and satisfaction; mentorship and sponsorship co-occurrence; and perception of inequities. Open-ended questions were analyzed using content analysis. Key Results Thirty-one percent of the surveyed faculty (903/2900) responded of whom 53% (477/903) were women and 10% (95/903) were URiM. Familiarity with sponsorship was higher among assistant (91%, 269/894) and associate (182/894; 64%) professors versus full professors (38%, 329/894); women (67%, 319/488) versus men (62%, 169/488); and URiM (77%, 66/517) versus non-URiM faculty (55%, 451/517). A majority had a personal sponsor (528/691; 76%) during their career and were satisfied with their sponsorship (64%, 532/828). However, when responses from faculty of different professorial ranks were stratified by gender and URiM identity, we observed possible cohort effects. Furthermore, 55% (398/718) of respondents perceived that women received less sponsorship than men and 46% (312/672) that URiM faculty received less than their peers. We identified seven qualitative themes: sponsorship importance, growing awareness and change, institutional biases and deficiencies, groups getting less sponsorship, people with sponsorship power, conflation with mentorship, and potential for negative impact. Conclusions A majority of respondents at a large academic health center reported sponsorship familiarity, receipt, and satisfaction. Yet many perceived persistent institutional biases and the need for systematic change to improve sponsorship transparency, equity, and impact.

Time and Travel Burden Associated with Hexapod-Assisted Correction of Lower Extremity Deformity

Background: Hexapod devices, colloquially referred to as frames, are powerful tools to correct lower extremity deformity. However, patients who undergo treatment with frames are followed closely to ensure that clinical and radiographic correction are satisfactory. Depending on the size of the state and the number of surgeons that offer frame treatment, patients may need to travel a long distance and frequently, to obtain care. We sought to characterize the number of clinical and surgical encounters, as well as the cumulative driving distance, for frame patients treated at a single academic health center. Methods: All patients treated with a hexapod frame for any etiology by three pediatric orthopaedic surgeons at a single children’s hospital over an 8-year period were investigated. Patients were queried for demographic data, number of non-surgical and surgical clinical encounters and number of days in the frame. Driving distance was calculated from the patients address to the academic health system address. Results: Thirteen patients qualified for inclusion (10 male, 3 female). Mean age at frame application was 14.6 years (range 4-31). Mean time in the frame was 150.5 days (range 90-207). Throughout the course of their frame treatment, patients had a mean of 16 non-surgical (range 5-26) encounters and a mean of 3 (range 2-6) surgical encounters. Mean one-way driving distance between the treating institution and the patient’s home was 77 miles (range 20-212 miles). When two way driving distance was multiplied by the total number of encounters for each patient, the mean distance driven was 2616 miles (range 862-7632 miles). Conclusion: In this cohort of patients with a lower extremity frame, there were on mean 16 non-surgical and 3 surgical encounters, with a mean driving distance during the treatment program of 2600 miles. When agreeing to undertake a hexapod-assisted program for lower extremity pathology, patients should be counseled about the temporal and financial nature of this strategy, so they are aware of the large commitment needed.

A Qualitative Study on Using Telemedicine for Precepting and Teaching in the Academic Setting.

To examine the impact of telemedicine use on precepting and teaching among preceptors and patients during the COVID-19 pandemic. The authors conducted a secondary analysis of a qualitative study focusing on providers' and patients' experiences with and attitudes toward telemedicine at 4 academic health centers. Teaching and precepting were emergent codes from the data and organized into themes. Themes were mapped to domains from the 2009 Consolidated Framework for Implementation Research (CFIR), a framework that assists with effective implementation and consists of 5 domains: intervention characteristics, outer settings, inner settings, characteristics of individuals, and process. In total, 86 interviews were conducted with 65 patients and 21 providers. Nine providers and 3 patients recounted descriptions related to teaching and precepting with telemedicine. Eight themes were identified, mapping across all 5 CFIR domains, with the majority of themes (n = 6) within the domains of characteristics of individuals, processes, and intervention characteristics. Providers and patients described how a lack of prepandemic telemedicine experience and inadequate processes in place to precept and teach with telemedicine affected the learning environment and perceived quality of care. They also discussed how telemedicine exacerbated existing difficulties in maintaining resident continuity. Providers described ways communication changed with telemedicine use during the pandemic, including having to wear masks while in the same room as the trainee and sitting closely to remain within range of the camera, as well as the benefit of observing trainees with the attending's camera off. Providers expressed a lack of protected structure and time for teaching and supervising with telemedicine, and a general view that telemedicine is here to stay. Efforts should focus on increasing knowledge of telemedicine skills and improving processes to implement telemedicine in the teaching setting in order to best integrate it into undergraduate and graduate medical education.

Perspectives on Benefits and Challenges to Developing a Co-Teaching and Co-Learning Exchange between Community and Academic Partners.

To train future professionals in health disparities and social determinants of health, academic health centers often use curricula exclusively developed and instructed by faculty. To examine the perceptions and attitudes of faculty and community stakeholders towards the benefits of and challenges to developing co-teaching/co-learning exchange programs. Faculty from six academic professional schools at a single institution and community members participated in focus groups. Interviews were video-recorded and reviewed for themes. Both faculty and community participants felt that partnering in the design and implementation of lectures addressing the social determinants of health could enhance curriculum and provide real-world context for the learning experience. Our findings add to the literature examining the benefits and challenges of engagement between faculty and community and offer new insights on the value of co-teaching/co-learning experiences.

P393 Physical activity participation and mental health status of patients with cystic fibrosis during the COVID-19 pandemic: a single centre experience

The COVID-19 pandemic has posed a significant mental health challenge to individuals worldwide. Little is known about the association between mental health and physical activity participation in patients with Cystic Fibrosis (CF) who are encouraged to exercise as part of their treatment regimen. This exploratory study aimed to determine physical activity levels, mental health status (anxiety and depression symptoms) and fear of illness (Fear of Illness and Viral Evaluation; FIVE) score among a sample of CF patients from our academic health center.

An Assessment of How Clinicians and Staff Members Use a Diabetes Artificial Intelligence Prediction Tool: Mixed Methods Study

Background Nearly one-third of patients with diabetes are poorly controlled (hemoglobin A1c≥9%). Identifying at-risk individuals and providing them with effective treatment is an important strategy for preventing poor control. Objective This study aims to assess how clinicians and staff members would use a clinical decision support tool based on artificial intelligence (AI) and identify factors that affect adoption. Methods This was a mixed methods study that combined semistructured interviews and surveys to assess the perceived usefulness and ease of use, intent to use, and factors affecting tool adoption. We recruited clinicians and staff members from practices that manage diabetes. During the interviews, participants reviewed a sample electronic health record alert and were informed that the tool uses AI to identify those at high risk for poor control. Participants discussed how they would use the tool, whether it would contribute to care, and the factors affecting its implementation. In a survey, participants reported their demographics; rank-ordered factors influencing the adoption of the tool; and reported their perception of the tool’s usefulness as well as their intent to use, ease of use, and organizational support for use. Qualitative data were analyzed using a thematic content analysis approach. We used descriptive statistics to report demographics and analyze the findings of the survey. Results In total, 22 individuals participated in the study. Two-thirds (14/22, 63%) of respondents were physicians. Overall, 36% (8/22) of respondents worked in academic health centers, whereas 27% (6/22) of respondents worked in federally qualified health centers. The interviews identified several themes: this tool has the potential to be useful because it provides information that is not currently available and can make care more efficient and effective; clinicians and staff members were concerned about how the tool affects patient-oriented outcomes and clinical workflows; adoption of the tool is dependent on its validation, transparency, actionability, and design and could be increased with changes to the interface and usability; and implementation would require buy-in and need to be tailored to the demands and resources of clinics and communities. Survey findings supported these themes, as 77% (17/22) of participants somewhat, moderately, or strongly agreed that they would use the tool, whereas these figures were 82% (18/22) for usefulness, 82% (18/22) for ease of use, and 68% (15/22) for clinic support. The 2 highest ranked factors affecting adoption were whether the tool improves health and the accuracy of the tool. Conclusions Most participants found the tool to be easy to use and useful, although they had concerns about alert fatigue, bias, and transparency. These data will be used to enhance the design of an AI tool.

Using Community-Based Participatory Research to Conduct a Collaborative Needs Assessment of Mental Health Service Users: Identifying Research Questions and Building Academic-Community Trust.

Attempts to meaningfully engage people with serious mental illnesses (SMI) as allies in conducting research have often failed because researchers tend to decide on the research topic without including community members. Academic researchers can avoid this pitfall by collaborating with community members to conduct a needs assessment to identify relevant research topics and build trust. Here, we report on the results of a psychosocial needs assessment for adult mental health service users in Massachusetts conducted by an academic-peer research team. The project was initiated as part of an academic mental health center's efforts to conduct community-based participatory research (CBPR) with a group of people with SMI. People with SMI were hired and trained to co-lead research projects and the development of the listening group guide, and they conducted 18 listening groups with 159 adults with mental health conditions. The data were transcribed, and rapid analysis employing qualitative and matrix classification methods was used to identify service need themes. Six themes emerged from qualitative analysis: reduce community and provider stigma, improve access to services, focus on the whole person, include peers in recovery care, have respectful and understanding clinicians, and recruit diverse staff. The policy and practice implications of these findings include creating a stronger culture of innovation within provider organizations, developing specific plans for improving recruitment and retention of peer workers and a multicultural workforce, enhancing training and supervision in cultural humility, communicating respectfully with clients, and including peers in quality improvement activities.

Implementation of CYP2C19 genotyping to guide proton pump inhibitor use at an academic health center.

To describe the implementation of CYP2C19 testing into clinical practice at University of Florida (UF) Health Gainesville hospital to guide proton pump inhibitor (PPI) dosing and the lessons learned from this experience. Different CYP2C19 genotypes are associated with variability in PPI plasma concentrations and intragastric pH, which may contribute to the risk of treatment failure due to subtherapeutic concentrations and adverse effects (eg, infection, bone fracture, renal dysfunction) with sustained supratherapeutic concentrations. Based on evidence available prior to the availability of pertinent Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines, the UF Health Precision Medicine Program (PMP) developed clinical recommendations, provided through automated alerts at the time of a PPI order, to (1) increase the PPI dose for individuals with genotypes linked to increased CYP2C19 enzyme activity (ie, rapid and ultrarapid metabolizers) to improve the likelihood of drug effectiveness and (2) decrease the dose for individuals with decreased CYP2C19 activity (ie, intermediate and poor metabolizers) to reduce the risk of harm. The CYP2C19-PPI implementation was an iterative process that taught us key implementation lessons. Most notably, physician engagement is essential, problem lists in the medical record are unreliable, and special populations (eg, pediatric patients) need to be considered. Guiding PPI prescribing based on CYP2C19 genotype is a practical approach to potentially improve the benefit-risk ratio with PPI therapy. Physician engagement is key for successful implementation. A CPIC guideline on CYP2C19 genotype-guided PPI dosing is now available, and automated alerts may be instituted to facilitate implementation.

Patient and researcher stakeholder preferences for use of electronic health record data: a qualitative study to guide the design and development of a platform to honor patient preferences.

This qualitative study aimed to understand patient and researcher perspectives regarding consent and data-sharing preferences for research and a patient-centered system to manage consent and data-sharing preferences. We conducted focus groups with patient and researcher participants recruited from three academic health centers via snowball sampling. Discussions focused on perspectives on the use of electronic health record (EHR) data for research. Themes were identified through consensus coding, starting from an exploratory framework. We held two focus groups with patients (n = 12 patients) and two with researchers (n = 8 researchers). We identified two patient themes (1-2), one theme common to patients and researchers (3), and two researcher themes (4-5). Themes included (1) motivations for sharing EHR data, (2) perspectives on the importance of data-sharing transparency, (3) individual control of personal EHR data sharing, (4) how EHR data benefits research, and (5) challenges researchers face using EHR data. Patients expressed a tension between the benefits of their data being used in studies to benefit themselves/others and avoiding risk by limiting data access. Patients resolved this tension by acknowledging they would often share their data but wanted greater transparency on its use. Researchers expressed concern about incorporating bias into datasets if patients opted out. A research consent and data-sharing platform must consider two competing goals: empowering patients to have more control over their data and maintaining the integrity of secondary data sources. Health systems and researchers should increase trust-building efforts with patients to engender trust in data access and use.

Patterns of Distress and Supportive Resource Use by Healthcare Workers During the COVID-19 Pandemic

Introduction:Healthcare workers (HCWs) are at increased risk of burnout, post-traumatic stress injury and suicide, compared to the public. Long-lasting increases in HCW distress are reported following pandemics. Such occupational stress can negatively impact individuals, organizations, and the overall healthcare system. Understanding HCW distress and needs can inform the development of resources to mitigate negative outcomes. Staff wellness data was gathered from a large academic health center during the COVID-19 pandemic, as part of a quality improvement project seeking to support staff wellbeing. Longitudinal trends of distress and preferences related to support were shared with leadership.Method:Monthly wellness assessments were sent to hospital staff via email. Assessments included screens for burnout, anxiety, depression and posttraumatic stress, questions regarding types of resources accessed, and open-ended questions regarding staff needs. Surveys were voluntary and confidential. Participants could provide their email to receive tailored resources based on individual results. Survey data was analyzed longitudinally to identify trends of distress over time.Results:A total of 2,518 wellness assessments were completed from April 2020-July 2021. An average of ~167 (range 17 – 946) HCWs responded per month and 638 staff provided their email addresses to receive a response; 497 of these completed assessments multiple times. The proportion of positive screens were, on average, 44%, 29%, 31% and 53%, for anxiety, depression, post-traumatic stress and burnout, respectively. Anxiety and post-traumatic stress scores decreased from April-August, then increased from September. The most reported source of support accessed was family/friends; ~40% of responders had not accessed formal mental health support.Conclusion:When COVID-19 cases decreased and stay-at-home mandates were lifted, HCW distress was reduced. Burnout trended upwards through the pandemic. Peer/family support remained favored compared to formal mental health support, suggesting the importance to HCW of social support. HCW reported a preference for convenient access to supportive resources.

Association Between ACEs and Postoperative Pain After Gynecologic Surgery [ID: 1377683

INTRODUCTION: Adverse childhood experiences (ACEs) are instances of abuse or household dysfunction that occur prior to 18 years of age. Numerous studies have demonstrated an increased risk of morbidity and mortality with increasing ACE scores. An association between ACEs and chronic pelvic pain has also been described; however, data for acute pain are lacking. This study evaluates the relationship between ACEs and acute postoperative pain after benign minimally invasive hysterectomies. METHODS: Institutional review board approval was obtained at a large academic health center. Consenting participants completed the ACEs survey prior to hysterectomy. Patient data were collected by retrospective chart review, including postoperative care unit pain scores. Descriptive statistics, Kruskal-Wallis tests, and Spearman’s correlation coefficients were utilized for analysis. Enrollment is ongoing with a recruitment goal of 112 participants. RESULTS: Preliminary analysis included 47 participants. Average patient age was 39.2±11.4 years. The average ACE score was 3.5±2.9 and 46.8% of participants had high ACE scores, defined as 4 or more. Although not statistically significant, patients with high ACE scores trended towards higher pain scores and morphine milligram equivalents (MME) usage. Maximum pain scores and required MME were 5.86 and 16.50 MME in the high-ACE group versus 4.88 and 7.50 MME in the low-ACE group, respectively (P=.41, P=.40). CONCLUSION: High ACE scores are greater than threefold more prevalent in our surgical study population compared to previously reported general population rates. Although preliminary data suggest ACE scores and postoperative pain are not associated, further data are needed.

Abstract #1402660: Association of Social Vulnerability Index Themes and Pre-Diabetes in Chicago Neighborhoods

Pre-diabetes, defined as a glycosylated hemoglobin between 5.7% and 6.4%, is a common condition that is amenable to intervention to ameliorate progression to diabetes. The distribution of pre-diabetes at the census tract level in diverse urban communities and the neighborhood factors that may influence community pre-diabetes rates are not well understood. The social vulnerability index (SVI) was created by the Centers for Disease Control and Prevention to study how communities may be affected following natural disasters. SVI scores range from 0 to 1 with higher SVI scores representing increased social vulnerability. SVI is composed of four neighborhood level themes — socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. The objective of this proof-of-concept project was to determine the distribution of pre-diabetes in patients from census tracts served by a single academic health center and to understand how census tract SVI scores amongst the four SVI themes may be associated with pre-diabetes. For data available in 2018, pre-diabetes rates varied from 0.5% to 16.7% for 1,203 out of the 1,313 census tracts for which there were at least 25 adult patients seen at Rush University Medical Center. A linear regression model was used to assess the change in SVI theme score with the rate of pre-diabetes. Each 0.1 unit increase in SVI theme score for the socioeconomic status, household composition and disability, and minority status and language themes were associated with a 0.37% (SE = 0.027; p-value < 0.0001), 0.36% (SE = 0.027; p-value < 0.0001), and 0.14% (SE = 0.029; p-value = 0.0045) increase in the rate of pre-diabetes, respectively. However, the housing and transportation theme had a non-significant 0.08% decreased rate of pre-diabetes per 0.1-unit change (SE = 0.029, p-value = 0.07). While there was significant heterogeneity of SVI theme scores and pre-diabetes rates in census tracts served by a single, urban health center, this proof-of-concept work shows a potential relationship between SVI themes and pre-diabetes rates at the census-tract level. If confirmed in future studies, SVI could be a tool for future targeted neighborhood-specific interventions to reduce the health impact of pre-diabetes, such as providing more resources to address disparities in socioeconomic status, household composition and disability, and minority status and language domains.

Lipopolysaccharide, Immune Biomarkers and Cerebral Amyloid-Beta Deposition in Older Adults With Mild Cognitive Impairment & Major Depressive Disorder

Inflammatory activation and increased immune response to lipopolysaccharide occur in both depression and cognitive decline and may link these two conditions. We investigated whether lipopolysaccharide (LPS), LPS binding protein (LBP) and peripheral biomarkers of immune response were associated with increased cerebral deposition of amyloid-beta (Abeta) in older adults with mild cognitive impairment (MCI) and remitted major depressive disorder (rMDD). Cross-sectional analysis. Five academic health centers in Toronto. Older adults with MCI with/without rMDD. We investigated the associations among serum LPS, LBP, biomarkers of inflammatory activation - Interleukin-6 (IL-6), C-reactive protein (CRP), monocyte chemoattractant protein-1 (MCP-1), and cerebral Abeta deposition quantified by positron emission tomography. Among 133 study participants (82 with MCI and 51 with MCI+rMDD) there was no association between LPS (beta - 0.17, p=0.8) or LBP (beta - 0.11, p=0.12) and global deposition of Abeta following adjustment for age, gender, and APOE genotype in multivariable regression analyses. LBP was positively correlated with CRP (r=0.5, p <0.001) and IL-6 (r=0.2, p=0.02) but no inflammatory biomarker was associated with Abeta deposition; rMDD was not associated with deposition of Abeta (beta -0.09, p=0.22). In this cross-sectional analysis, we did not find an association among LPS/LBP, immune biomarkers or rMDD and global deposition of Abeta. Future analyses should assess the longitudinal relationships between peripheral and central biomarkers of immune activation, depression and cerebral Abeta deposition.

Network Analysis of Academic Medical Center Websites in the United States

Healthcare resources are published annually in repositories such as the AHA Annual Survey DatabaseTM. However, these data repositories are created via manual surveying techniques which are cumbersome in collection and not updated as frequently as website information of the respective hospital systems represented. Also, this resource is not widely available to patients in an easy-to-use format. Network analysis techniques have the potential to create topological maps which serve to aid in pathfinding for patients in their search for healthcare services. This study explores the topological structure of forty United States academic health center websites. Network analysis is utilized to analyze and visualize 48,686 webpages. Several elements of network structure are examined including basic network properties, and centrality measures distributions. The Louvain community detection algorithm is used to examine the extent to which these techniques allow identification of healthcare resources within networks. The results indicate that websites with related healthcare services tend to form observable clusters useful in mapping key resources within a hospital system.

Patients presenting to a united states academic health center emergency department following opioid overdose show elevated rates of Hepatitis C and limited testing history

Patients presenting to a united states academic health center emergency department following opioid overdose show elevated rates of Hepatitis C and limited testing history

Defining and prioritizing urgency for outpatient neurology referrals (P6-7.003)

<h3>Objective:</h3> To evaluate the current outpatient scheduling process for urgent neurology referrals in order to reduce wait times at a large academic center. <h3>Background:</h3> Long wait times for time-sensitive outpatient neurology referrals delay time to diagnosis and increase emergency room visits. At our academic health center, internal referring physicians use an electronic health record order to request outpatient neurology appointments. This order includes a priority checkbox (“urgent” vs “routine”), but does not require additional information about referral reason. Non-clinical schedulers then rely on referrer-deemed urgency to prioritize new patient visits without neurologist review. <h3>Design/Methods:</h3> For this quality improvement initiative, retrospective chart review was performed on 150 patients to assess referrer judgment of neurologic urgency. Using referral management software, new patient appointment wait times were tracked for eight months in 2021. Based on these data, metrics of neurologic urgency were created. <h3>Results:</h3> Definitions of neurologic urgency vary between neurologists and referrers. Referrer judgment of urgency was found to be 41% sensitive and 64% specific. Wait times for referrals marked “routine” averaged 34 days, whereas wait times for neurologist-deemed urgent patients averaged 35 days. Based on our retrospective study, we identified 5 main predictors of time-sensitive outpatient neurology referrals: new persistent sensory loss or weakness; immunosuppression or being treated for cancer; abnormal brain or spine imaging; currently pregnant; new or recurrent loss of consciousness or seizure-like episodes. <h3>Conclusions:</h3> Relying on referrer urgency designation is a poor way to triage neurologic urgency of referrals. This leads to long wait times for time-sensitive neurologic conditions. Specific questions can be used to define urgency rather than an urgency check box. We plan to implement these questions in our EHR referral system and trend impact on wait times, number of urgent referrals, and specificity of these questions to predict neurologic urgency. <b>Disclosure:</b> Dr. Rivera-Torres has nothing to disclose. Dr. Quigley has nothing to disclose. Dr. Roberts has nothing to disclose. Dr. Do has nothing to disclose.